Eyeworld

EW CATARACT 47 He continued, "We like to think we know how to prevent infections, but what we don't know is much bigger than what we know, and I think that's the take-home message from this paper—that there's a lot we don't know." The one thing that everyone agrees on is that using 5% povidone- iodine prep works, Dr. Packer said. Other than that, there aren't any good comparisons among different protocols and regimens, he said. Even the endophthalmitis study un- dertaken by the European Society of Cataract & Refractive Surgeons, which was a huge effort, didn't give a definitive answer, Dr. Packer said. Use of intracameral antibiotics However, looking at the situation today with the evidence available, it certainly is appealing to believe that the use of intracameral antibiotics, especially in a timed-release form, which maintains a high concentra- tion inside the eye during the post- op period, would be a great thing, Dr. Packer said. "I think everyone believes that it's bugs inside the eye that cause the damage so we should put antibiotics inside the eye. There's hesitancy to do that especially in the United States because we don't have an ap- proved antibiotic to put inside the eye," he said. This is an issue that goes to off- label use and the role of the FDA be- cause it's almost impossible to do a study that would show effectiveness of an intracameral antibiotic for the prevention of endophthalmitis as the incidence is so low; it would take a huge number of subjects, perhaps a quarter of a million, to do a study like that, Dr. Packer said. A commercial preparation would alleviate the fears that "home-brewed" intracameral antibi- otics can cause TASS or other signifi- cant problems, he added. Growing resistance The review found mounting evi- dence that there are more resistant organisms such as methicillin-resis- tant staphylococcus aureus and staphylococcus epidermidis, which are becoming bigger culprits in terms of causative organisms, Dr. Yoo said. "I think the main conclusion is that we don't have the definitive recommendation on what is the best way to prevent endophthalmitis. I wish we could say, 'Here's what you could do, let's make it easy,'" Dr. Packer said. "What we have is a series of sug- gestions and the recognition that a variety of different approaches are probably valid, but we don't have a way to determine what the best one is," he said. EW Editors' note: Drs. Mamalis, Packer, and Yoo have no financial interests related to this article. Contact information Mamalis: 801-581-6586, nick.mamalis@hsc.utah.edu Packer: 541-687-2110, mpacker@finemd.com Yoo: 305-326-6322, syoo@med.miami.edu pre-op post-op FREE SAMPLES LID SCRUB ™ "LEAVE-ON" WITH MOISTURIZER ENHANCE Post-Op Results ENHANCE ENHANCE ost-Op Results Post-Op Results ENHANCE ost-Op Results ost-Op Results ost-Op Results Post-Op Results ost-Op Results ost-Op Results September 2011

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